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Table 2.4 Other Cardiovascular Conditions in Patients Without Symptoms of Ischemia

From: ACC/AHA/ASE/ASNC/ASPC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2023 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Chronic Coronary Disease

Clinical Scenario Text

ECG Treadmill

Stress Nuclear MPI

Stress Echo

Stress CMR

CAC

CCTA

Cath

No Test

Newly-Diagnosed Heart Failure (Resting LV Function Previously Assessed but No Prior CAD Evaluation)

51.

Newly diagnosed HFpEF

M (4)

A (7)

A (8)

A (7)

R (3)

A (7)

M (6)

R (3)

52.

Newly diagnosed HFrEF

M (4)

A (7)

A (8)

A (8)

R (2)

A (7)

A (8)

R (1)

53.

Screening for transplant vasculopathy

R (3)

A (7)

A (7)

A (7)

R (1)

A (7)

A (8)

 

Evaluation of Arrhythmias Without Ischemic Equivalent (No Prior Cardiac Evaluation)

54.

Infrequent PVCs

M (4)

R (2)

R (2)

R (2)

R (2)

R (1)

R (1)

A (8)

55.

Frequent PVCs or nonsustained VT

A (7)

A (7)

A (7)

A (7)

R (3)

M (6)

M (5)

M (4)

56.

Paroxysmal supraventricular tachycardia

M (5)

R (2)

R (3)

R (3)

R (1)

R (2)

R (1)

M (5)

57.

New-onset atrial fibrillation/flutter

M (5)

R (3)

R (3)

R (3)

R (2)

R (3)

R (1)

M (5)

58.

Prior to initiation of antiarrhythmic therapy in patients with high global CAD risk

M (6)

A (7)

A (7)

A (7)

R (3)

A (7)

R (3)

R (3)

59.

Exercise-induced VT

A (7)

A (7)

A (8)

A (7)

R (2)

A (7)

A (7)

R (1)

60.

Sustained VT

A (7)

A (7)

A (7)

A (7)

R (2)

A (7)

A (7)

R (1)

61.

Ventricular fibrillation

M (4)

A (7)

A (7)

A (7)

R (1)

A (7)

A (8)

R (1)

Syncope Without Ischemic Equivalent

62.

Initial evaluation suggests CV abnormalities

A (7)

A (7)

A (7)

A (7)

R (3)

M (6)

M (5)

R (3)

63.

Initial evaluation suggests other etiology

M (4)

R (3)

M (4)

R (3)

R (2)

R (2)

R (1)

M (6)

Cardio-oncology

64.

Prior chest radiation, no symptoms, > 5 y ago

M (4)

M (4)

M (6)

M (5)

M (6)

M (6)

R (2)

M (5)

  1. If grayed out, rating not applicable
  2. A = Appropriate; CAC = coronary artery calcium score; CAD = coronary artery disease; cath = cardiac catheterization; CCTA = coronary computed tomography angiography; CMR = cardiac magnetic resonance; CV = cardiovascular; ECG = electrocardiogram; echo = echocardiography; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction; M = May Be Appropriate; MPI = myocardial perfusion imaging; PVC = premature ventricular contraction; R = Rarely Appropriate; VT = ventricular tachycardia